Beltway Update is an occasional column keeping you up to date on timely Congressional and administrative action on mental and behavioral health bills and policy in Washington, DC.
Every couple of years when the summer before an election begins, the Capitol seems to grow quieter by the week until it’s all but vacant. This year’s midterm elections take place November 8, but somehow the Capitol is abuzz with a rare focus on meaningful mental health policy reforms. How is this possible during an election year? And will anything actually get done? As always, it’s too soon to tell.
Mental health policy is taking shape on two separate tracks. The first is the reauthorization of mostly existing programs in the House Energy and Commerce and Senate Health, Education, Labor and Pensions (HELP) committees. But a place where multiple new policy initiatives – and new funding – may emerge is the Senate Finance Committee, where both Republicans and Democrats recognize the need to bolster the nation’s fragile mental health system. And now, in the last week, a bipartisan group of Senators have announced progress on a gun-violence prevention package that may include significant mental health components.
Why is mental health policy in focus?
Two years of bleak headlines on mental health have highlighted the need for access to mental health and substance use services.
At the end of 2021, Surgeon General Vivek Murthy declared a youth mental health crisis and pointed to alarming rates of hopelessness, depression and suicide among America’s young people. Last month, the CDC announced that overdose deaths in 2021 hit 108,000, the largest number on record. Rates of depression and anxiety across the country have remained high as the Covid-19 pandemic rolls on. Finally, the recent mass shootings seem to have inspired Congress to try to do something.
What actions might come, and where and when could they happen?
A good chunk of existing federal mental health dollars come through the 21st Century Cures Act, first passed in 2016. It includes funding for two agencies – the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA). The House Energy & Commerce Committee and the Senate HELP Committee are leading efforts to reauthorize the Cures Act.
In May, Energy and Commerce voted a bipartisan SAMHSA and HRSA reauthorization out of committee that included some increases in funding levels for existing programs and new dollars to coordinate implementation of the new 988 crisis line and crisis services and a new collaborative care program designed to better integrate behavioral health and primary care. The House Rules Committee is expected to consider it during the week of June 20 as one of the final steps before it can be passed.
In the Senate, the HELP Committee is expected to release the final draft sections of the reauthorization in late June or early July and to make final committee-level changes after the July 4th recess.
The X Factor: Senate Finance Committee
If major new initiatives and funding for mental health emerge from this Congress, they will originate either in the Senate Finance Committee or – as of the last two weeks – from a bipartisan group of Senators that is working to craft a gun-violence prevention package. Last fall, the Finance Committee released a Request for Information from stakeholders on unmet needs in mental health care, signaling members’ interest in putting together a package that would include new initiatives and funding.
The committee created five sub-groups, each led by one Democrat and one Republican, each focused on a different priority: strengthening the workforce, increasing integration, coordination and access to care, ensuring parity between behavioral and physical health care, furthering the use of telehealth, and improving access to behavioral health care for children and young people. The goal was to formulate a bipartisan mental health package.
So far, the committee has released drafts for telehealth and for youth mental health, with drafts for the other areas expected later this month. The telehealth draft has one measure likely to please mental health advocates. It would remove a provision requiring providers to see a client in person in the six months before a telehealth visit would be covered by Medicare. Overall, a new bill could provide north of $10 billion in funding for new programs, depending on how negotiations go. Again, the committee is likely to finalize the full bill after the July 4th recess.
Since a budget reconciliation bill – which can be passed by a simple majority – was never passed last year in the Senate, there is still an opportunity for Democrats to use that process to pass a bill with some limited health care provisions. Possibilities include boosting Affordable Care Act (ACA) subsidies for people in states that didn’t expand Medicaid and increasing funding for a Medicaid program that cares for seniors and people with disabilities at home or in community-based settings rather than nursing homes and hospitals.
A gun violence package – with mental health funding – is in the works. Can it pass this Congress?
On June 12, a bipartisan group announced a framework for a gun-violence package with significant mental health components. Senators Murphy (D-CT), Cornyn (R-TX), Sinema (D-AZ), and Tillis (R-NC) are leading negotiations, and the package looks like it may be in the $10 billion range. While we wait to learn more policy specifics, word is they’d like to pass it before July 4th if the schedule allows.
This bill may include funding for school-based mental health and support services, expanded telehealth services for youth and families in crisis and a nationwide expansion of the Certified Community Behavioral Health Clinic (CCBHC) program within Medicaid. It may also include funding for mental health, suicide prevention and other community-based support services, including crisis and trauma intervention and recovery. If this package moves swiftly with a sizeable mental health component, it could ease the pressure on other committees to include these items in their packages.
What are the obstacles?
The biggest obstacle to all these reforms is the calendar. The closer things get to the August recess and the November midterms, the tougher it will be to get things done. Plus, new spending requires finding ways to pay for it. Since these packages are being formulated on a fully bipartisan basis, it could be challenging to find offsets both sides can agree on. Tricky negotiations lie ahead, and they will determine the overall size of the final packages.
The clearest way to wrap up the packages coming from the different committees may be to merge them with the FY 2023 appropriations bills in an end-of-year “omnibus bill” that combines multiple spending bills. A busy June and July lies ahead – but the final outcome of whatever bills emerge from these committees may not be clear until after the November mid-terms.
Sarah Corcoran is vice president of government relations at Guide Consulting Services (GCS), a government relations consulting practice based in Washington, DC. GCS represents mental health providers, technology companies, patient advocacy organizations and state mental health agencies before Congress and the administration. A complete list of GCS clients can be found here.